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. 2025 May;29(5):431-440.
doi: 10.5005/jp-journals-10071-24966. Epub 2025 May 8.

Effect of High Protein Normocaloric Nutrition on Skeletal Muscle Wasting in Critically Ill Mechanically Ventilated Patients: A Randomized Double-blind Study

Vetriselvan Parasuraman  1 , Rahul K Anand  1 , Puneet Khanna  1 , Rakupathy Shanmugam  1 , Bikash Ranjan Ray  1
Affiliations

Effect of High Protein Normocaloric Nutrition on Skeletal Muscle Wasting in Critically Ill Mechanically Ventilated Patients: A Randomized Double-blind Study

Vetriselvan Parasuraman et al. Indian J Crit Care Med. 2025 May.

Abstract

Background and aims: Muscle wasting in critically ill patients is associated with poor outcomes. During intensive care unit (ICU) stay, delivering appropriate nutritional support helps minimize muscle loss. We sought to evaluate the impact of high-dose protein on muscle thickness and cross-sectional area (CSA), as well as to track changes in muscle echogenicity and pennation angle (PA) using bedside ultrasound in this population.

Patients and methods: We conducted a randomized, prospective, double-blind trial in which 30 patients mechanically ventilated for more than 48 hours and receiving enteral feed were enrolled. Patients were divided into two groups, and all patients received enteral feeds with total calories of about 25 kcal/kg/day. In the high-protein feed (HPF) group, patients were targeted to receive 1.5 gm/kg/day of protein, whereas in the standard feed (SF) group, patients received 1 gm/kg/day of protein. After ICU admission, muscle thickness, CSA, echogenicity, and PA were measured in all mechanically ventilated patients on days 1, 3, 5, and 7 using bedside ultrasound. The right lower limb vastus lateralis (VL) and the medial head of the gastrocnemius were investigated.

Results: We found a progressive decrease in muscle mass from day 1 to day 7 in all patients. Our study showed that muscle thickness and CSA were significantly higher in the HPF group than the SF group over 7 days, whereas muscle echogenicity and PA changes were not statistically significant.

Conclusion: High-protein feeds prevent muscle wasting in critically ill patients compared to patients receiving SFs during the first week of ICU stay. The qualitative muscle parameters, like muscle echogenicity and PA changes, were not significant.

How to cite this article: Parasuraman V, Anand RK, Khanna P, Shanmugam R, Ray BK. Effect of High Protein Normocaloric Nutrition on Skeletal Muscle Wasting in Critically Ill Mechanically Ventilated Patients: A Randomized Double-blind Study. Indian J Crit Care Med 2025;29(5):431-440.

Keywords: Critical illness; High protein diet; Muscle wasting; Nutrition.

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Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Figs 1A to F
Figs 1A to F
Represent images of VL and gastrocnemius. (A) Vastus lateralis; (B) Gastrocnemius; (C) Muscle thickness; (D) Cross-sectional area; (E) Echogenicity; (D) Pennation angle
Fig. 2
Fig. 2
Flow participants in the study
Figs 3A to D
Figs 3A to D
Quantitative muscle changes in VL and gastrocnemius muscle
See this image and copyright information in PMC

References

    1. Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, de Jonghe B, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009;37(10 Suppl):S299–S308. doi: 10.1097/CCM.0b013e3181b6ef67. - DOI - PubMed
    1. Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591–1600. doi: 10.1001/jama.2013.278481. - DOI - PubMed
    1. Moisey LL, Mourtzakis M, Cotton BA, Premji T, Heyland DK, Wade CE, et al. Nutrition and Rehabilitation Investigators Consortium (NUTRIC). Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care. 2013;17(5):R206. doi: 10.1186/cc12901. - DOI - PMC - PubMed
    1. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. Canadian Critical Care Trials Group. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–693. doi: 10.1056/NEJMoa022450. - DOI - PubMed
    1. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014;370(17):1626–1635. doi: 10.1056/NEJMra1209390. - DOI - PubMed

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